HomeMy WebLinkAboutAFFIDAVIT - 21-00170 - Oxford - Approx. 459 W Main - RezoneSubmit by E-mail
35 North Ise East
Rexburg, !D 83440
Affidavit of Legal Interest
City of Rexburg
State of Idaho
County of Madison
Name
City
Phone: 208.359.3020
www.rexburg.org Fax: 208.354.3022
CITY Of
REXBURG
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Address V
Stater
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Being first duly sworn upon oath, depose and say:
(If Applicant is also Owner of Record, skip to B)
A. That I am the re ord owner of the property described on the attached, and I rant my
permission to: b t
Name L Address
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to submit the accompanying application pertaining to that property.
B. I agree to indemnify, defend and hold Rexburg City and its employees harmless from any
claim or liability resulting from any dispute as to the statements contained herein or as to the
ownership of the property which is the subject of the application.
Dated this k day of MGVAA---' 20
2-
Signature
Subscribed and sworn to before me the day and yc�rr rst above written.
Notary Public of Idaho
U)-1 a-ftUM residing at:
My commission expires:
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189
A notary public or other officer completing this certificate verifies only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California
County of Madera
On March 10 2021 before me, Jennie Abdill Notary Public ,
Gate Here Insert Name and Title of the Officer
personally appeared .Tames R. Maxwell
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(-&) is/ate
subscribed to the within instrument and acknowledged to me that he/she_/the-y executed the same in
his/]ler/their authorized capacity(tes- , and that by his/hexdtheir signature(o on the instrument the person(),
or the entity upon behalf of which the person(s) acted, executed theinstrument.
h
JENNIEABDiLL
Notary Public - California z
Madera County
Commission # 2206466
My Comm. Expires Jul 22, 2021
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and official seat.
J
Signature
Sig ature Notary Public
Place Notary Seal Above
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document:
Document Date:
Signer(s) Other Than Named Above:
Capacity(i+es) Claimed by Signer(s)
Signer's Name:
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
ber of Pages:
Signer's Name:
❑ Corporate Officer — Title(s):
❑ Partner— ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
F] Other:
Signer Is Representing: